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Family Christian Academy
If you have 4 or more students this year, the 4th student and up are discounted to $20 each. (Discount applies to K-8th grade only.)
Program
Enrollment Date

MonthDayYear
Date
School Year*

24-25Other

Student Information
Type of Enrollment*

New Enrollment (Never been enrolled)Re-Enrollment (Enrolled last year)Returning Student (Not enrolled last year)
Student Name*

First NameMiddle NameLast Name
Student Gender*

MaleFemale
Grade*
Student D.O.B*
MM/DD/YYYY
SSN
555-55-5555
Address*

Address

Street Address Line 2

CityState

Zip
County*
County.*
(Not country)

Previous School Information
You must provide a valid school fax number or email address to request records. Please contact your previous school and ask for the best fax and/or email for records requests. Records will not be requested without this information.
Previous School Attended*
Not Applicable
Previous School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous School Phone*
Previous School Fax
Previous School Email
example@example.com

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IMPORTANT:
Submission of this enrollment form acknowledges that...
You have read and agreed to Family Christian Academy's Policies.
You understand that submitting any false information will result in the immediate nullification of this enrollment.

FCA does not provide refunds for services.
How many students in this family have already been enrolled for the selected school year?
Large family discount $50. Call for discount code. (615)-847-3999.
Parent/Guardian Signature*

Clear
Coupon Code:
Enrollment:
Early Discount:
New Student Processing:
Card Processing:
Total:

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USDDescription

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Afterpay